Pyelonephritis secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]


Pyelonephritis can be prevented secondarily in some cases by giving long term prophylactic antibiotics. Correction of a structural defect that leads to the initial episode of pyelonephritis may also be helpful in eliminating chances of recurrence of pyelonephritis.

Secondary Prevention

  • If no structural or functional abnormality is identified, some studies suggest long-term preventative (prophylactic) treatment with antibiotics, either daily or after sexual intercourse.[1]
  • In children at risk of recurrent UTIs, the evidence is inconclusive as to whether long-term prophylactic antibiotics are of use.[2]
  • Ingestion of cranberry juice has been studied as a prophylactic measure; while studies are heterogeneous, many suggest a benefit.[3]

Antimicrobial Prophylaxis

  • Prophylaxis is required in individuals having two or more episodes of urinary tract infections in 6 months or three or more episodes in 12 months period.[4][5]
  • Prophylactic therapy using antimicrobial agents may be considered as either continuously or postcoital prophylaxis for 6 to 12 months.
  • The following regimens may be used as single doses prior to sexual activity.[6]
  • Prophylactic Therapy:
  • Preferred regimen (1): Fosfomycin tromethamine 3 g PO in a single dose
  • Preferred regimen (2): Nitrofurantoin monohydrate/macrocrystals 100 mg PO in a single dose
  • Preferred regimen (3): Trimethoprim-Sulfamethoxazole 160/800 mg PO double-strength tablet bid in a single dose
  • Preferred regimen (4): Trimethoprim 100 mg PO bid in a single dose
  • Alternative regimen (1): Ciprofloxacin 250 mg PO bid in a single dose
  • Alternative regimen (2): Levofloxacin 250 mg PO qd in a single dose
  • Alternative regimen (3): Norfloxacin 400 mg PO bid in a single dose
  • Alternative regimen (4): Gatifloxacin 200 mg PO qd in a single dose


  1. Schooff M, Hill K (2005). "Antibiotics for recurrent urinary tract infections". American family physician. 71 (7): 1301–2. PMID 15832532.
  2. Williams GJ, Wei L, Lee A, Craig JC (2006). "Long-term antibiotics for preventing recurrent urinary tract infection in children". Cochrane database of systematic reviews (Online). 3: CD001534. doi:10.1002/14651858.CD001534.pub2. PMID 16855971.
  3. Raz R, Chazan B, Dan M (2004). "Cranberry juice and urinary tract infection". Clin. Infect. Dis. 38 (10): 1413–9. doi:10.1086/386328. PMID 15156480.
  4. Nicolle LE, Ronald AR (1987). "Recurrent urinary tract infection in adult women: diagnosis and treatment". Infect Dis Clin North Am. 1 (4): 793–806. PMID 3333659.
  5. Ronald AR, Conway B (1988). "An approach to urinary tract infections in ambulatory women". Curr Clin Top Infect Dis. 9: 76–125. PMID 3077293.
  6. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.
  7. Melekos MD, Asbach HW, Gerharz E, Zarakovitis IE, Weingaertner K, Naber KG (1997). "Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women". J Urol. 157 (3): 935–9. PMID 9072603.
  8. Brumfitt W, Hamilton-Miller JM (1998). "Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18 years' experience". J Antimicrob Chemother. 42 (3): 363–71. PMID 9786476.
  9. Rudenko N, Dorofeyev A (2005). "Prevention of recurrent lower urinary tract infections by long-term administration of fosfomycin trometamol. Double blind, randomized, parallel group, placebo controlled study". Arzneimittelforschung. 55 (7): 420–7. doi:10.1055/s-0031-1296881. PMID 16080282.

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